Healthcare Provider Details

I. General information

NPI: 1639853229
Provider Name (Legal Business Name): JONATHAN SPIKES DSW, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NW 79TH ST STE 342
MIAMI FL
33150-3016
US

IV. Provider business mailing address

PO BOX 380861
MIAMI FL
33238-0861
US

V. Phone/Fax

Practice location:
  • Phone: 305-230-4598
  • Fax: 305-230-4626
Mailing address:
  • Phone: 305-230-4598
  • Fax: 305-230-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016337
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: